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This section is going to focus on the actions that communities do or don’t take and how they affect individuals and consumer’s health. The central theme here is one related to externalities. Externalities is a concept that is used very frequently in economics, and it refers to the spillovers that exist in lots of economic transactions, that have an impact on one party or another who is not directly involved in the transaction. For example, when a business pollutes the air, that has spillover effects on individuals who live in the area near the polluting business, and yet they haven’t had an opportunity to weigh in on the issue of whether or not the business should be polluting the air. In these instances, prices in the marketplace don’t reflect the full cost or benefits in the production or consumption of the product or service. When the externality is a positive one, like green lawns, then people are getting benefits when their neighbors keep up their yards, the whole neighborhood looks nicer, and everyone gets the benefit of the hard work that the homeowner has put into keeping their lawn up. So, that is a positive externality. When the impact is negative, or detrimental to the consumer, we speak of it as a negative externality. These impose costs on us as consumers, the costs may be detrimental health effects, or higher out of pocket costs to pay for health care, and communities quite often the source of both positive and negative externalities, and so we are going to spend some time talking about externalities and how they affect individual health. For the first part, we are going to look at community differences in various aspects of consumer/family health. Then, we will look at the role that the local socio-environment play in affecting consumer and family health and what communities can try to do to improve people’s health.Differences in family and consumer health can arise because of the political choices that local communities make, as well as because of the local geography.

Soon after establishing his dental practice in Colorado Springs, Colorado, in 1901, Dr. Frederick S. McKay noted an unusual permanent stain or &quot;mottled enamel&quot; (termed &quot;Colorado brown stain&quot; by area residents) on the teeth of many of his patients. After years of studying it, he decided that it was caused by an agent in the water. He also observed that teeth affected by this condition seemed less susceptible to dental caries. It was later found that the water contained high levels of fluoride.Dr. F. L. Robertson, a dentist in Bauxite, Arkansas, noted the presence of mottled enamel among children after a deep well was dug in 1909 to provide a local water supply. A hypothesis that something in the water was responsible for mottled enamel led local officials to abandon the well in 1927. Later, high concentrations of fluoride were found in the water of the abandoned well.

During this time, extensive dental caries was common in the United States and in most developed countries. No effective measures existed for preventing this disease, and the most frequent treatment was tooth extraction. Dental caries is an infectious, communicable, multifactorial disease in which bacteria dissolve the enamel surface of a tooth. Untreated, the bacteria can result in tooth loss and discomfort. Failure to meet the minimum standard of having six opposing teeth was a leading cause of rejection from military service in both world wars

The hypothesis that dental caries could be prevented by adjusting the fluoride level of community water supplies from negligible levels to 1.0-1.2 ppm was tested in a prospective field study conducted in four pairs of cities (intervention and control) starting in 1945: Grand Rapids and Muskegon, Michigan; Newburgh and Kingston, New York; Evanston and Oak Park, Illinois; and Brantford and Sarnia, Ontario, Canada. After conducting sequential cross-sectional surveys in these communities over 13-15 years, caries was reduced 50%-70% among children in the communities with fluoridated waterThe studies in these cities demonstrated the oral health benefits of fluoridated water in communities and established water fluoridation as a safe, practical, effective public health measure that would prevent cavities. Of the 50 largest cities in the United States, 43 have community water fluoridation. Currently, more than 162 million Americans (65% of the population served by public water systems) live in areas where the fluoride level is adjusted in the water supply to bring it to the level considered best for dental health. Fluoridation of community drinking water is considered to be a major factor responsible for the decline in dental caries (tooth decay) during the second half of the 20th century. The history of water fluoridation is a classic example of clinical observation leading to epidemiologic investigation and community-based public health intervention. Although other fluoride-containing products are available, water fluoridation remains the most equitable and cost-effective method of delivering fluoride to all members of most communities, regardless of age, educational attainment, or income level.

What does Fluoride do? * Helps to build stronger teeth enamel. * Stops or reverses the tooth decay process. * Prevents loss of important minerals.Fluoride protects teeth from decay and cavities in two ways. When bacteria in the mouth combine with sugars, acid is produced that can erode tooth enamel and damage teeth. Fluoride can protect teeth from demineralization that is caused by the acid. If teeth have already been damaged by acid, fluoride accumulates in the demineralized areas and begins strengthening the enamel - a process called remineralization. Fluoride is very useful for preventing cavities and strengthening teeth, but its effectiveness is thwarted if a cavity has already formed.

Utah Specific:Fifty-eight percent of Utah children six through eight years of age have at least one filling or untreated cavity. These rates are higher than in many other areas of the country. Utah adults also have dental restorations and decay at a rate that is above the national average. Only 3% of Utah citizens are serviced by community water systems with optimal levels of fluoride- the lowest in the nation. There are many Utah communities, such as West Valley City, that have natural fluoride in the drinking water but at sub-optimal levels. In Utah, Brigham City and Helper have been fluoridating their water systems for more than 35 years.When was fluoride implemented into Salt Lake County? Fluoridation of public water systems began Oct. 1, 2003

Fluoridated water is said to be most cost effective way to get fluoride to the largest number of people. Taking fluoride drops or pills can be hard to remember, certain demographics might not have as great of access to them. Those who are using fluoride toothpastes, or taking other supplements are still getting the same amount as everyone else

Tobacco Statistics:Tobacco’s Grim Statistics:Each year, more than 393,000 Americans die from smoking caused diseases. Another 50,000 die from exposure to secondhand smoke. Each day, almost 3,900 kids try their first cigarette. More than 950 become regular, daily smokers.

Mounting scientific evidence shows that effective tobacco control policies lead to fewer kids starting to smoke and more smokers quitting. However, elected officials continue to fail to enact these proven measures. In this year’s report not a single state or the federal government qualifiedfor all “A” grades for enacting strong and effective tobacco control laws. Ironically, this comes at a time when tobacco control policies, such as smokefree laws, are extraordinarily popular with the public. Each state’s grades reflect how well the state’s tobacco control laws measure up to the best in the nation or to goals set by federal agencies such as the Centers for Disease Control and Prevention (CDC). Many states have hard-working tobacco control coalitions that encounter stiff resistance from state legislators and powerful tobacco interests. The grades in this report in no way reflect the level of effort invested by the public health community. Instead, it is the responsibility of elected officials to muster the political will to enact these life- and revenue-saving policies.

There are pros and cons on the smoking ban issue. But the most commonly claimed pro is that there are so many scientific medical reasons that smoking in public should be banned. Not only does smoking hurt the person who is smoking, but recent scientific and medical evidence shows that the dangers associated with second hand smoking are extremely serious and relevant. This takes the wind out of the argument that says, &quot;I choose to smoke, and it&apos;s only my body I am hurting.&quot; When you smoke in public, you are putting everyone around you at risk. This includes the employees of the establishment where you are smoking. Many workers at bars find they are suffering from the same physical symptoms that smokers face because of the impact of second hand smoke at their place of employment.Some that argue against a public smoking ban argue that it will adversely affect certain types of businesses. For example, those who own bars say that part of the draw of a bar is the freedom to smoke when you wish in the bar. Research seems to indicate, however, that the opposite is indeed true.Of course, businesses that are under a smoking ban must be creative to provide outdoor areas for their smoking patrons, but many businesses are finding that their business increases because non-smokers are more comfortable in the environment than they were when smoking was allowed. In restaurants, smokers are no longer lingering over cigarettes enjoying conversation and taking up a table that a new customer who will have a new bill could be using. When smokers pay their bill and leave to enjoy their cigarette, then a new customer can use the table, bringing in more income to the restaurant or bar.When arguing the pros and cons on the smoking ban, many say that telling people they cannot smoke in public is a violation of their personal rights. Others say it is hypocritical to ban cigarettes and then continue to tax the products that are so bad for consumers. This is a major argument, because many countries and US states receive high amounts of revenue from the tax on cigarettes, yet they will not let the smokers use those products in public.

Everyone is affected by the quality of our air, whether indoors or outdoors.Ever since people first gathered in settlements there has been pollution. Pollution usually refers to the presence of substances that are either present in the environment where it doesn&apos;t belong or at levels greater than it should be.Air pollution is caused by any undesirable substance, which enters the atmosphere. Air pollution is a major problem in modern society. Even though air pollution is usually a greater problem in cities, pollutants contaminate air everywhere. These substances include various gases and tiny particles, or particulates that can harm human health and damage the environment. They may be gases, liquids, or solids. Many pollutants are given off into the air as a result of human behavior. Pollution occurs on different levels: personal, national, and global.Particulate matter is the general term used for a mixture of solid particles and liquid droplets found in the air. Some particles are large or dark enough to be seen as soot or smoke. Others are so small they can be detected only with an electron microscope. When particulate matter is breathed in, it can irritate and damage the lungs causing breathing problems. Fine particles are easily inhaled deeply into the lungs where they can be absorbed into the blood stream or remain embedded for long periods of time.

How does air pollution affect me?Many studies have shown links between pollution and health effects. Increases in air pollution have been linked to decreases in lung function and increases in heart attacks. High levels of air pollution according to the EPA Air Quality Index directly affect people with asthma and other types of lung or heart disease. Overall air quality has improved in the last 20 years but urban areas are still a concern. The elderly and children are especially vulnerable to the effects of air pollutionThe level of risk depends on several factors: * the amount of pollution in the air, the amount of air we breathe in a given time our overall health.Other, less direct ways people are exposed to air pollutants are:* eating food products contaminated by air toxins that have been deposited where they grow, * drinking water contaminated by air pollutants, * ingesting contaminated soil, and touching contaminated soil, dust or water.

The Air Quality Index is a tool used by EPA and other agencies to provide the public with timely and easy-to-understand information on local air quality and whether air pollution levels pose a health concern. The AQI tells the public how clean the air is and whether or not they should be concerned for their health. The AQI is focused on health effects that can happen within a few hours or days after breathing polluted air.

Air Quality by CountyThe Clean Air Act identifies 6 criteria pollutants (CO, Lead, NO2, Ozone, Particulate Matter, SO2) Establishes National Ambient Air Quality Standards (NAAQS) for each in order to protect public health UDAQ monitors the air to determine whether or not Utah is meeting these standards

Most of Utah’s Wintertime Particulate is fine particulate, which lodge deeply into the lungs and are associated with serious health problems, including heart and lung diseases, and even in some cases, premature death. This wintertime smog develops in, and is trapped by, mountain valleys and temperature inversions. including the health of &quot;sensitive&quot; populations such as asthmatics, children, and the elderly.Carbon Monoxide, Lead, Nitrogen Dioxide, Particulate Matter, Ozone, and Sulfur Dioxide.

According to the Utah Division of Air Quality, if all drivers living along the Wasatch Front were to park their cars just one day per week, vehicle emissions would be reduced by 6,500 tons per year. This means that every vehicle trip counts, and every mile you devote to smarter travel pays Utah back with cleaner, more breathable air. In 2010, The Clear the Air Challenge, issued by Governor Huntsman, Mayor Becker and Mayor Corroon, is a six-week competition starting June 1st that gives you the chance to reduce your vehicle emissions by choosing alternatives to driving alone using TravelWise strategies. By driving less and driving smarter, you will ultimately help improve air quality, reduce traffic congestion and conserve energy in Utah. You will also be eligible for weekly and grand prize drawings by meeting straightforward, achievable travel goals.As a community more than 100,00 trips were eliminated, more than 1 million miles were saved, and 1.8 million pounds of emissions

The Centers for Disease Control (CDC) stress that it is a myth to think that because vaccinations have enabled the U.S. to reduce most vaccine-preventable diseases to very low levels, we no longer have to worry about these diseases. Even though these vaccine- preventable diseases are at low levels in the U.S., many of them are prevalent in other parts of the world and can be brought into the country by travelers. Epidemics could be caused here if we are not protected by vaccinations, and the relatively few cases in the U.S. could quickly become thousands of cases. The CDC gives two reasons why vaccination is important. First, we need to protect ourselves and our children, and second, we need to protect those around us. There is a small number of people who cannot be vaccinated (because of severe allergies to vaccine components, for example), and a small percentage of people don&apos;t respond to vaccines. These people are susceptible to disease, and their only hope of protection is that people around them are immune and cannot pass disease along to them. Many vaccine preventable diseases have severe effects. For example, Pertussis results in prolonged coughing spells that can last for many weeks, making it difficult for a child to eat, drink, and breathe. Vomiting often occurs after a coughing spell, so infants may lose weight and become dehydrated. In infants, Pertussis can also cause pneumonia and lead to brain damage, seizures, and mental retardation. The risks are similar with measles. As many as one out of 20 children with measles gets pneumonia, and about one child in every 1,000 who gets measles will develop encephalitis. This is an inflammation of the brain that can lead to convulsions, and can leave a child deaf or with mental disabilities. Additionally, of every 1,000 children who get measles, one or two will die from it. Measles can also cause pregnant women to have miscarriages, premature births and low- birth-weight babies.

Mumps is a contagious disease that leads to painful swelling of the salivary glands. The salivary glands produce saliva, a liquid that moistens food and helps you chew and swallow.Symptoms: Face pain,Fever,Headache,Sore throat,Swelling of the parotid glands (the largest salivary glands, located between the ear and the jaw), and Swelling of the temples or jaw (temporomandibular area).It may also infect the,Central nervous system,Pancreas, and the TestesIn 2006, the United States experienced a multi-state outbreak involving 6584 reported cases of mumps. This resurgence predominantly affected Midwestern college students with the highest attack rates occurring among those living in dormitories. In the following two years, the number of reported cases returned to usual levels, and outbreaks involved fewer than 20 cases. However, beginning in July 2009, the largest U.S. mumps outbreak since 2006 has occurred. The index case was an 11-year-old boy who had returned on June 17 from the United Kingdom where an ongoing mumps outbreak involves more than 4000 cases.

Comes from the reading that you did. Reasons parents gave for not having their children vaccinated were…When you think of children not receiving their vaccinations, most often you would think that it was because of lack of education, not having much money, and this shows that children who are unvaccinated don’t really fit into that.

As you can see, Utah was at the top of the list for states in the U.S. who had unvaccinated children. And then within Utah, there were also several counties that made the list, Salt Lake County, Utah County, and Washington County.

So, the general theme throughout all of these, the geographical and also the political choices that communities have made, is …To take care of them and their families, or is some government intervention and community action needed.But as with many things in life,

6.
During both world wars, failure to meet the minimum standard of having 6 opposing teeth was a leading cause of rejection from military service</li></li></ul><li>Community Water Fluoridation<br />Field Studies were done in cities in Michigan, Illinois, and Ontario Canada, to test adjusted water fluoridation<br /><ul><li>Cross-sectional surveys in these communities over 13-15 years, caries was reduced 50%-70% among children in the communities with fluoridated water </li></ul>*From the Utah Dept. of Health<br />

8.
Utah & Water Fluoridation<br />Utah children and adults had more cavities and higher tooth decay than the national average<br /><ul><li>Many Utah communities have natural fluoride in the drinking water

9.
Some communities like Brigham City and Helper have been fluoridating their water systems for more than 35 years

10.
Fluoride wasn’t implemented into Salt Lake County until October 1, 2003.</li></ul>*From the Utah Dept. of Health<br />

11.
The Controversy<br />Individual Choice vs. Community<br />Are other means for receiving fluoride<br />Toothpaste, tablets or drops<br />Fluoride in large doses can be toxic<br />Can’t really control the dosage because people drink different amounts of water<br />

13.
How Does Utah Measure Up?<br />C<br />FY2011 State Funding for Tobacco Control Programs: $7,131,700<br />FY2011 Federal Funding for State Tobacco Control Programs: $1,527,000*<br />FY2011 Total Funding for State Tobacco Control Programs: $8,658,700<br />Percentage of CDC Recommended Level: 36.7%<br />*Includes regular funding from the CDC and Prevention as well as tobacco-related grants to states and communities from federal stimulus and health care reform funds.<br />$1.70<br />*On July 1, 2010, the cigarette tax increased from $.695 to $1.70 per pack<br />D<br />BARRIERS TO COVERAGE: Prior authorization required for some medications and minimal co-payments required<br />BARRIERS TO COVERAGE: Annual limit on quit attempts, prior authorization required fro some medications, and minimal co-payments required<br />STATE QUITLINE:<br />Investment Per Smoker: $8.64; CDC recommends an investment of $10.53/smoker<br />*From the American Lung Association<br />

15.
Geographical Factors: Air Quality<br />Everyone is affected by the quality of air<br />Pollution presence of substance that is either present in the environment where it doesn’t belong or at greater levels than it should be<br />Pollution occurs on different levels <br />

25.
Geographical Factors: Unvaccinated Children<br /><ul><li>2.1 million children 19-35 months of age are undervaccinated, including children who have received no vaccines</li></ul>Annually, 17,000 children were unvaccinated<br /><ul><li>At increased risk of acquiring and transmitting vaccine-preventable diseases.</li></li></ul><li>Recent Outbreaks of Vaccine Preventable Diseases<br />2006 multi-state outbreak of mumps<br />Affected Midwestern College students<br />6,584 reported cases-usually less than 20 cases<br />July 2009<br />Index case: 11-year old boy visited the UK-went to summer camp where it was passed on to 25 people<br />Spread to 4 counties in New York, 1 county in New Jersey, and Quebec Canada<br />*Information from: The Journal of the American Medical Association<br />Mumps Outbreak—New York, New Jersey, Quebec, 2009<br />

29.
The Theme:<br />Juggling individual rights with collective good<br />Individual responsibility<br />Government Intervention<br />For most part everyone wants to do what’s best for them and their family, while also being considerate of others<br />Individual choices can affect others<br />